Article
Removable Prosthodontics at a Glance
This is a book with a difference, written by two consultants in restorative dentistry and prosthodontics. It is brimful of relevant diagrams, clinical illustrations and simulated clinical illustrations. It starts by stating that removable prosthodontics has being described as a black art – the Marmite of dentistry: practitioners either love it or hate it! It then proceeds to enthusiastically cover every aspect of removable prosthodontics that this reviewer can think of.
The first page covers an important topic in any sort of dentistry, but probably in my view, is central to success in removable prosthodontics, namely communication, I quote: ‘The patient will need to have time to adapt slowly to their new prosthesis’, this being particularly important for the complete denture patient. This reviewer started by calling each section a chapter until the penny dropped that the style of the book was that each ‘chapter’ contained only two pages – diagrams and illustrations on the left page and text on the right, for a total of 47 sections, as opposed to chapters! In that regard, each ‘section’ is really a guide in itself, with this reviewer being amazed at the clarity with which each subject was discussed in one page and a series of (excellent) diagrams.
From section 2 on the functions of a removable prosthesis, section 3 deals with stability and retention. Similarly, section 4 on patient assessment for partial dentures and then number 5 on edentulous ridge presentations and the significance of these. In section 6, the content returns to patient assessment for partial dentures – was chapter 5 slightly out of place, I asked myself? The guide to ‘factors influencing success’ and ‘operator position’ are great reads, followed by a section on anatomy, before the book gets into the clinical nitty gritty of impressions, special trays, impression compound (how great to see that that still has a place!), functional upper and lower impressions, managing fibrous ridges and recording the maxilla–mandibular relationship. There are also excellent sections on occlusal dimensions and occlusal schemes, the neutral zone, copying features from existing prostheses, saddles rests and claps, connectors and bracing, with surveying nicely described and discussed. Add to this, four appendices containing denture and restorative assessment proformae, a guide to referral letters and a partial denture design sheet.
Throughout this excellent book, the copious diagrams complement the text by way of clinical tips – for example, encourage the patient to close in the retruded arc of closure until the first contact occurs, then register together passively with silicone paste. Readers who wish to purchase an at-a-glance guide to help with clinical technique, rather than a reference text, need look no further than this book. Readers also gain access to a companion website that includes quiz questions and assessment forms for download.
Historical note on the cover image: the Harrington clockwork drill
Until the middle of the 19th century, two-handed Archimedes and bow-string drills were the only available mechanical devices for the removal of caries. This severely restricted the ability of the dentist to safely undertake intra-oral procedures with no ‘free’ hand to retract, and so protect soft tissues and simultaneously give better visual access to the clinical environment.
George Fellows Harrington (1812–1895) started his dental career in Portsmouth, and later Ryde, and was an early graduate of the Licentiate in Dental Surgery (LDS) from the Royal College of Surgeons, England in 1860.
Throughout his long life, George Harrington was not just a dentist, but a scientist and inventor with two patents to his name. The first in 1858 for an improved design for artificial teeth, and the second in 1864 for a dental clockwork drill operated with one hand. This revolutionary idea used a ‘barrel spring’ tensioned by an external key and, by means of linkages and cogs, turned the cutting bur in a straight or right-angle connector (see front cover) for up to 2 minutes before re-winding. Over the years Harrington refined his design to reduce the noise when in use. The retail cost was £6.6s.0d.
In 1871, Harrington took his invention to the USA, convinced it would be a great success. However, his timing could not have been worse. That same year Morrison introduced the foot-treadle drill, which swept the market and left Harrington with a financial disaster.
On his death, his estate was valued at only £452.10s.7d; not a great deal for a man of his dedication and talent.